The Brothers Osbourne growled out of the radio as we headed east through the hardwoods of Kentucky, the crest of each hill revealing a valley more beautiful that the last. My friend Roy Vandiver and I were road-tripping from Dallas to Appalachia, retracing the trajectory of Hillbilly Elegy, J.D. Vance’s memoir of growing up in Jackson, Kentucky and Middletown, Ohio.

Jackson, Kentucky

In the book, Vance relates a childhood where he was raised by his grandmother, became a near surrogate parent to his drug-plagued mother, and was tarnished by exposure to the opiate use, welfare dependence and lack of ambition of the society around him. He made it out, and eventually went to Yale law school. While Vance makes no excuses for his family, he has sharp elbows for political class promises of opportunity and social justice.

Byron Harris, a 40 year reporter for WFAA-TV, writes Byron’s lens.

When Elegy was released last year it gained buzz as a chronicle of Appalachia, and by extension, a summary of the ills of white rural America. J.D. Vance became a paid commentator on CNN, called on to analyze Donald Trump’s appeal to white blue-collar voters.

WATCH: What's Trump's appeal to the working class?

The sardonic twang of “It Ain’t My Fault” seemed to encapsulate the political finger-pointing of the past two years, as well as the frustration of people just trying to get by. As we drove into Jackson, we knew we wouldn’t find out whose fault it all was. But we were looking.

Kentucky has the third highest drug overdose rate in the nation. Jackson, Kentucky’s death rate is not the highest in the state. But compared to Dallas, Texas, Jackson has a huge drug problem.

Jackson is the county seat of Breathitt County, which has a population of only 13, 400. Yet between 2010 and 2015, Breathitt county’s death rate from overdoses was 38 per one hundred thousand people, more than three times that of Dallas County for a similar period, which is 11 per one hundred thousand people, according to the Centers for Disease Control. At least 21 people died of overdoses in Breathitt between 2010 and 2015. One official suspects the number may be higher because county coroners regularly list ‘cardiac arrest’ as a cause of death rather than ‘drug overdose.’ Counties near Breathitt have death rates four to six times that of Dallas, Kentucky Public Health records show.

“If you want to know about drugs in Jackson, go out to the Walmart,” Jeff Noble, the editor of the Jackson-Breathitt Times-Voice told us.

Everybody in town calls it the Walmart, but it’s really the Jackson Village Shopping Center, the closest thing Jackson has to a mall. Jackson Village, it turns out, is also home to three store front for-profit recovery centers.

On a weekday evening at Jackson Village, people were literally lined up waiting to get into one clinic. Jackson is a mecca for opiate addiction treatment. There’s a van that’s brought patients in from neighboring counties, one of several a week. Since there are only fifteen seats in the Jackson Recovery Clinic, patients nervously mill around outside or sit in cars in the parking lot until a chair opens up. This being a Thursday, with the clinic closed on the weekend, patients receive enough anti-opiate medication for a couple of days after undergoing a counselling session.

Despite the anxiousness, there is a kind of acceptance here, as if they all are part of a large family. Yes, we all share an addiction to opiates. Oxycontin, heroin, fentanyl. Yes, it all began with an injury or a surgery and the Doctor prescribed this painkiller, they will tell you. And yes, opiates have ruined my life.

Regina Smith and Shayla Barger rode together this evening with a transportation service from a neighboring county. “For this generation it’s (drugs) especially bad. We were supposed to be the smart ones in our high school,” Barger says. “Now all of our classmates are dead,” Smith says. “I lost a brother, a brother-in-law and a husband to drugs. I’ve lost a lot of people to drugs. That’s why I decided to seek help.”

While both say their travails began with post-injury prescriptions, they also say that drug habits are often passed on from parents to children.

Jerry Campbell, the manager of the Jackson Recovery Clinic, told me prospects for success are generational. Some of his patients—usually those over sixty--will be in treatment, receiving medication, for the rest of their lives. In the next age bracket, forty to sixty, some may be able to graduate from treatment, he said. And his hope is younger patients, if properly counselled, can put drugs totally behind them.

In the parking lot one afternoon I saw a woman in a black t-shirt, pacing, with sweat on her upper lip. I asked her if she’d talk to me. “Not now, hon, got an appointment with my doctor.”

Later I found her sitting in the front seat of a car with her son, and she did agree to talk if I wouldn’t use her name.

She is 41. And shot heroin for a decade. “Did it bother you to inject the first time?” “No.” she answered quickly. In 2015, she said, she’d had Narcan shots four different times to bring her back from overdoses. That was in Ohio, about seven miles from Middletown. She had moved the two hundred miles from Ohio to Kentucky because she believed treatment in Jackson was better. “She’s much better now than I’ve ever seen her,” said the son, who’d grown up with an addict for a mother. Never a user himself, he’s now her caregiver, similar to J.D. Vance.

Like a pool of blood, heroin has been spreading across Appalachia for years. It will seep into one county, coagulate until demand is saturated, and then bleed into the next. Jackson County Police chief Ken Spicer says that for addicts the lure of heroin is simple. An 80 mg. oxycontin tablet costs at least $100, and the high may only last a couple of hours. A bag of heroin costs $5, and the high may last all day. The danger with heroin for users is they never know what’s been added to it. Some suppliers are adding fentanyl, an opiate as much as fifty times more potent than oxycontin, to their heroin. The combination has produced multiple deaths in the United States and Canada.

Chief Spicer says oxycontin use began tapering off last year, but is being replaced by methamphetamines, which instead of being sedatives like oxycontin, are stimulants.

In the early 2000’s oxycontin was nicknamed ‘hillbilly heroin.’ Now the real thing is taking effect. The Kentucky Office of Drug Control Policy says 34% of drug deaths in the state involved heroin last year. 47% involved heroin.

In Breathitt County, the median household income was $25,800 from 2010 to 2015, nearly $20,000 less than Kentucky as a whole. (U.S. Census)

At the Walmart pharmacy in Jackson, it’s not unusual to see customers with half empty pill bottles trying to return their unused medications for cash. It never works, but they’re desperate. It’s not about opiates, it’s about poverty.

Five of the ten poorest counties in America are within a hundred and fifty miles of here, grouped like a clenched fist in the eastern part of the state. One in ten people in Breathitt county is unemployed, according to the St. Louis Federal Reserve, and the average per capita income, census figures show, was $15,737 between 2010 and 2015.

This is coal country. When coal was booming in the 70’s and 80’s everybody could get a job. It wasn’t unusual, locals say, to see a Cadillac parked next to a mobile home. Eskill Sizemore, now 71, was there as coal spooled up, working drills in the mines. “It was goin’ full blast,” he says with a grin. “ People had money to spend, money to spare.” The bust came faster than the ascent, though. Almost overnight it seemed, mortgage defaults mushroomed, cars were set afire to avoid payments, and the stores on Main Street in Jackson shut down. Mr. Sizemore’s mining career lefthim with spots on his lung, an oxygen tank and four stents in his heart.

Eskill Sizemore, 71, prospered in the coal mines, but now lives with spots on his lungs, an oxygen tank and four stents.

The former headquarters of Falcon Coal is now a homeless shelter. Falcon is in bankruptcy.

At the Hazard Flea Market, about 30 miles from Jackson, the three long sheds used to be a beehive on weekends. On a recent Saturday, though, there were more sellers than buyers. Smiley’s gold and silver exchange was empty. In another small booth, all that was for sale were a few hundred used movie DVD’s. There, an older man wearing an oxygen mask played a board game called Poppitt with his granddaughter. Counting out his next move , “one,two,three,four five..” he could barely breathe by the time he got to “six.”

“There is no money to be made around here,” says David Felkner. He and his business partner buy pallets of returned merchandise from big box retailers, repair it and resell it. His biggest mover:fishing poles. “If we didn’t do this, we wouldn’t make it,” he says.

David Felkner: There is no work to be had.

Kermit Clemons’ family has one of the biggest spaces in the Market, and he’s seen lots of ebbs and flows in the decade his family’s had a presence here. “A couple of years ago, this place would have been crawling with people,” he says. Generous terms and real concern for his customers, he says, have kept him in business. He allows his customers to take home the chain saws, guns, toy trucks, guitars and VHS tapes he sells them and pay him a little bit at a time. His busiest period is at the end of the month just after folks get their government checks. Nearly a third of Breathitt County’s residents under 65 have a disability, Census figures show.

Kermit Clemons. Business picks up toward the end of the month when people get their government checks.

“A lot of the best and the brightest have left,” Jeff Noble, the newspaper editor says. But at a Jackson city council meeting I attended there is optimism. Council is told that the Heritage Festival, the ‘Pig Out’ celebration of pulled pork and music, was a success. Progress is being made on infrastructure, part of a long range preparation for a turnaround in Breathitt county.

Vice Mayor Stephen Bowling thinks revival will come, but it will be at least a decade. It will take planning and energy, he says. He bristles at the stereotype of the hillbilly, while at the same time acknowledging that “there are people in our community who consciously do not do well in school and plan on drawing a disability check all their lives.” At the same time, he notes that many Jackson residents commute three hours by car each day to the Toyota plant in Georgetown, Kentucky.

He has spoken to J.D.Vance about Hillbilly Elegy, which even though a year old, still draws strident criticism from locals for its descriptions of lassitude and drug use. Vance’s response, according to Bowling, is that the book is a memoir about one person’s life and not an indictment of a community.

The Vice Mayor, who’s lived in Jackson all his life, sees the area’s economic problems and the opiate crisis as separate issues with a few common threads. Bowling is the county historian and has an emotional investment in this place. He is currently the county librarian, but has a Masters in Management and plans to run for mayor. Appalachia’s poverty, he maintains, stems from dependence on one industry, geographic remoteness, and education. While education may lag in parts of Eastern Kentucky, he says, the people who live here are not stupid. He sees a need for the region to develop a service economy not based on natural resources.

Lack of hope may be a common driver in economic failure and opioid addiction, but, he says, “there is not a single issue you can point to and say that is why so many people in Eastern Kentucky are on opioids. It’s really a mixture of many different things. It’s the lack of self-sufficiency. It’s the fact that dreams have been crushed by some of the challenges people face in Eastern Kentucky.”

The way out of both problems, which he says Vance, Hillbilly Elegy’s author, agrees with, is personal choice. “Ultimately, it comes down to the choices we make as individuals.”

Which doubles the irony of “It Ain’t My Fault.”

I got my hands upI need an alibiFind me a witness who can testifyYou made a mistakeYou got the wrong guyI’m only guilty of a damn good time